title: Prediction of retinal pigment epithelial tear in serous vascularized pigment epithelium detachment.
abstract: OBJECTIVE
  The aim of the study was to identify predictive factors for detection of impending retinal pigment epithelium (RPE) tears in patients under anti-VEGF therapy for treatment of retinal pigment epithelial detachment (PED) due to exudative age-related macular degeneration (AMD) using near-infrared reflectance imaging (NIR), spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FLA).
  
  
  METHODS
  We retrospectively evaluated NIR, SD-OCT and FLA images, number of intravitreal injections as well as demographical data of 103 eyes of 98 patients with vascularized PED [48.5% fibrovascular PED (fPED), 51.5% serous vascularized PED (svPED)] secondary to AMD.
  
  
  RESULTS
  Fifteen eyes with svPED of 103 included eyes (14.6%) developed an RPE tear under anti-VEGF therapy. Prior to RPE tear formation, we could identify radial hyperreflective lines spreading in a funnel-like pattern across the PED lesion in NIR images in 11 eyes correlating with folds in the RPE on corresponding SD-OCT scans (mean observation period: 115.4 ± 66.6 days; mean number of injections: 3.2 ± 1.5; mean PED height 828.2 ± 356.5 μm). In nine RPE tears (81.8%), the edge of the tear could be clearly localized on the opposite side of the PED lesion in relation to the origin of hyperreflective lines. None of the fPED patients showed the described signal.
  
  
  CONCLUSIONS
  Patients under anti-VEGF therapy for treatment of svPED due to AMD frequently show radial hyperreflective lines in NIR images prior to RPE tear development that correspond to wrinkled changes in the RPE. Hyperreflective lines may serve as an indicator for an impending RPE tear in svPED patients.
authors.affiliation: Department of Ophthalmology, University of Muenster Medical Center, Muenster, GermanyDepartment of Ophthalmology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Clemens
authors.forename: Nina
authors.initials: N
authors.lastname: Bastian
authors.forename: Florian
authors.initials: F
authors.lastname: Alten
authors.forename: Carolin
authors.initials: C
authors.lastname: Milojcic
authors.forename: Peter
authors.initials: P
authors.lastname: Heiduschka
authors.forename: Nicole
authors.initials: N
authors.lastname: Eter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007259:Infrared Rays; D058449:Intravitreal Injections; D008297:Male; D009389:Neovascularization, Pathologic / Q000175:diagnosis*; D009887:Ophthalmoscopy; D012163:Retinal Detachment / Q000175:diagnosis* / Q000209:etiology; D012167:Retinal Perforations / Q000175:diagnosis*; D055213:Retinal Pigment Epithelium / Q000098:blood supply*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000150:complications* / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
keywords: age-related macular degeneration; near-infrared; optical coherence tomography; pigment epithelium detachment; pigment epithelium tear